What Predicts Smoking Cessation and Reduction Among Smokers Enrolled in a Web-Based Intervention Post-Hospitalization?

Rationale: Hospitalization is considered a window of opportunity for smoking cessation and reduction. Tobacco control policies and smoking intervention programs during hospitalization can yield substantial reduction and cessation among hospitalized smokers. Brief in-hospital interventions often do not convert temporary smoking abstinence into long-term abstinence. Interventions continuing beyond discharge are essential to achieve long-term effects. Web-based interventions have been considered as a potential low-cost e-health approach for post-discharge care, and shown effective among the general population. This has not been examined for care-transition among hospitalized patients yet. We explored the use of a web-based smoking cessation intervention and its impact among other known predictors of smoking abstinence and reduction. Methods: We recruited smokers at a tertiary care hospital between July 2011 and May 2013. After providing informed consent, participants’ provided demographics, smoking attitudes and behaviors, and then given website access and automated emails set-up that lasted up to 6 months. 30-day point prevalence abstinence and, for non-quitters, smoking rate (number of cigarettes per day in last 30) was assessed at 6-months. Chi square and t-tests examined differences in characteristics between quitters and non-quitters and among those who reduced smoking vs. those who did not. Results: Of 748 smokers assigned to the web-intervention, 700 (93.6%) accessed the website at least once, with website access averaging 2.3 times, on 1.9 days, with 5.1 pages viewed. 141.5 (SD=90.8) emails were sent on average. 607 (81%) participants completed six-month follow-up. Self-reported 30-day point prevalence smoking abstinence was 31.3% while 66.2% of continued smokers reported reduced smoking. There was no significant difference between the quitters and non-quitters regarding the usage of website. Quitters were more likely to have higher self-efficacy (p<.001), intended to quit (p<.001), not smoked during hospitalization (p<.001), received more peer (p<.001) and expert messages (p<.001), had fewer doctor visits (p=.031), not used alternative tobacco products (p=.015), and to be male (p=.024). Those who reduced smoking were more likely to have higher self-efficacy (p=.027), intended to quit (p=.048), not smoked during hospitalization, accessed more web pages (p=.017), and had more ER (p=.004) and other healthcare visits (p=.008). Conclusions: Some aspects of the web-intervention were predictive of changes in smoking behaviors. However, overall, hospitalized smokers’ self-efficacy for not smoking, smoking behaviors while hospitalized and intentions regarding quitting appear to be important predictors of smoking cessation and reduction. Future hospital-based interventions should focus on enforcing abstinence during patient stays and strengthening patients’ self-efficacy and quitting intentions.

Duke Scholars

Author Meifang Chen DKU Faculty